1497323463 NPI number — MARIA TRINA GUZMAN SLATTON RPT

Table of content: MARIA TRINA GUZMAN SLATTON RPT (NPI 1497323463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497323463 NPI number — MARIA TRINA GUZMAN SLATTON RPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLATTON
Provider First Name:
MARIA TRINA
Provider Middle Name:
GUZMAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAN JOSE
Provider Other First Name:
MARIA TRINA
Provider Other Middle Name:
GUZMAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1497323463
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/15/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
240 MARIETTA HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30114-2311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-720-0290
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
240 MARIETTA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30114-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-720-0290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT007891 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com